A pediatric case and literature review of mucormycosis: Diagnostic and treatment challenges in a resource poor setting

Mucormycosis is an emerging disease that primarily affects immunocompromised patients; however, it has also been reported in immunocompetent individuals. Studies in the pediatric population are limited and reported mostly in case studies or series. The aim of this case report is to present a pediatric mucormycosis originated from Sumatra Island, Indonesia. A 13-year-old boy was referred to a tertiary hospital with facial necrosis involving the nasal, oral, and left maxillary areas, as well as left periorbital edema. No known underlying conditions were documented. The diagnosis was confirmed by histopathological findings of broad, pauci-septate, ribbon-like hyphae branching at 90°. The patient was managed by a multidisciplinary team consisting of the ear, nose, and throat, infectious diseases, dermatology, surgery, microbiology, and pathology departments. Management of the patient included debridement of the necrotic lesion and antibiotics and anti-fungal (fluconazole). Due to unavailability, the patient was not treated with amphotericin B. The patient died after 30 days of admission. This case highlights the importance of maintaining a high suspicion of invasive mucormycosis, even in immunocompetent children, when symptoms and signs are present, especially in resource-limited settings.

Development of a multiassay algorithm (MAA) to identify recent HIV infection in newly diagnosed individuals in Indonesia

Ongoing HIV transmission is a public health priority in Indonesia. We developed a new multiassay algorithm (MAA) to identify recent HIV infection. The MAA is a sequential decision tree based on multiple biomarkers, starting with CD4+ T cells >200/μL, followed by plasma viral load (pVL) > 1,000 copies/ml, avidity index (AI) < 0 · 7, and pol ambiguity <0 · 47%. Plasma from 140 HIV-infected adults from 19 hospitals across Indonesia (January 2018 - June 2020) was studied, consisting of a training set (N = 60) of longstanding infection (>12-month) and a test set (N = 80) of newly diagnosed (≤1-month) antiretroviral (ARV) drug naive individuals. Ten of eighty (12 · 5%) newly diagnosed individuals were classified as recent infections. Drug resistance mutations (DRMs) against reverse transcriptase inhibitors were identified in two individuals: one infected with HIV subtype C (K219Q, V179T) and the other with CRF01_AE (V179D). Ongoing HIV transmission, including infections with DRMs, is substantial in Indonesia.

Maternal visual perception of children’s nutritional status and feeding style

Background Mothers’ visual perception is an important determinant for their children’s nutritional status. Visual perception of their children’s nutritional status is believed to drive mothers to modify or apply certain feeding styles, which influence the probability of either optimal growth or malnutrition. Objective To determine if maternal visual perception of children’s nutritional status influences maternal feeding style. Methods The study was conducted in 3 kindergartens in Medan, North Sumatera, involving children aged 4-5 years and their mothers. Mothers filled three-part questionnaires, consisting of basic information, a series of body image sketches by a graphic artist to assess maternal visual perception, and the Parental Feeding Style Questionnaire (PFSQ) to assess maternal feeding style. Children’s body heights and weights were measured to assess their nutritional status. Results A total of 102 subjects were eligible for this study. Surprisingly, more than half of the mothers involved in our study misinterpreted their children nutritional status. Thus, there was no significant relationship between maternal visual perception, nor maternal misperception, and maternal feeding style. In fact, mothers tended to encourage their children to eat when they considered their children to have normal nutritional status. Conclusion Mothers’ visual perception does not influence feeding practice.

Quality of life in children with congenital heart disease after cardiac surgery

Background Major achievements in congenital heart disease (CHD) treatment over the past 20 years have altered the course and prognosis of CHD. Improvement of quality of life (QoL) is now a major goal of CHD treatment.Objective To assess the QoL in children after cardiac surgery for CHD.Methods A cross-sectional study was performed in children aged 2 to 18 years. The case group had 20 children with a history of corrective heart surgery in the 12 months prior to the study. The control group had 20 healthy children, age-matched  to the case group. The QoL of both groups was assessed by Pediatric Quality of Life Inventory (PedsQL) Generic Core Scales. The same post-operative children were also assessed with the PedsQL Cardiac Module. Data were analyzed using T-test with P < 0.05 as the level of significance.Results This study recruited 40 subjects: 20 post-operative and 20 healthy children. PedsQL Generic Core Scales assessment showed significant differences between groups in the physical function parameter of QoL (P<0.05) in children aged 13-18 years, but there were no significant differences in the social, emotional, and school function parameters. In children aged 2-12 years, there were no significant differences in physical, social, emotional, or school parameters. The PedsQL Cardiac Module assessment revealed that 35% of post-operative children was at risk for physical appearance problems, 80% was at risk for anxiety problems, 40% was at risk for cognitive problems, and 80% was at risk for communication problems.Conclusion Thirteen to 18-year-old children with non complex CHD have poorer physical function than healthy children. Post operative children are at risk for physical appearance, anxiety, cognitive, and communication problems.

Serum 25-hydroxyvitamin-D level and atopic dermatitis severity in children

Background Vitamin D plays an important role in the immune system. It inhibits B-lymphocyte proliferation and modulates the humoral response to suppress IgE production. Studies on the relationship between serum 25-hydroxyvitamin-D level and the severity of atopic dermatitis in several countries have had varying results.Objective To assess for a possible correlation between serum 25-hydroxyvitamin-D level and atopic dermatitis severity in children.Methods A cross-sectional study was conducted in 26 children with atopic dermatitis from September to December 2015. We evaluated the severity of disease using the Scoring of Atopic Dermatitis (SCORAD) index and measured serum 25-hydroxyvitamin-D levels. Spearman’s test was used to analyze for a correlation between serum 25-hydroxyvitamin-D level and the atopic dermatitis  score in children with atopic dermatitis.Results Mean SCORAD index was 32.0 (SD 14.99) , with a range of 10.9 to 71.4. Mean serum 25-hydroxyvitamin-D level was 41.1 (SD 24.81) ng/mL, with a range of 10-137 ng/mL. There was a moderate correlation between serum 25-hydroxyvitamin-D level and the SCORAD index (r=-0.591), with higher SCORAD index associated with lower serum 25-hydroxyvitamin-D level (P=0.01).Conclusion There is a moderate correlation between serum 25-hydroxyvitamin-D level and the SCORAD index in children with atopic dermatitis.

Quality of life in children with congenital heart disease after cardiac surgery

Background Major achievements in congenital heart disease (CHD) treatment over the past 20 years have altered the course and prognosis of CHD. Improvement of quality of life (QoL) is now a major goal of CHD treatment.Objective To assess the QoL in children after cardiac surgery for CHD.Methods A cross-sectional study was performed in children aged 2 to 18 years. The case group had 20 children with a history of corrective heart surgery in the 12 months prior to the study. The control group had 20 healthy children, age-matched  to the case group. The QoL of both groups was assessed by Pediatric Quality of Life Inventory (PedsQL) Generic Core Scales. The same post-operative children were also assessed with the PedsQL Cardiac Module. Data were analyzed using T-test with P < 0.05 as the level of significance.Results This study recruited 40 subjects: 20 post-operative and 20 healthy children. PedsQL Generic Core Scales assessment showed significant differences between groups in the physical function parameter of QoL (P<0.05) in children aged 13-18 years, but there were no significant differences in the social, emotional, and school function parameters. In children aged 2-12 years, there were no significant differences in physical, social, emotional, or school parameters. The PedsQL Cardiac Module assessment revealed that 35% of post-operative children was at risk for physical appearance problems, 80% was at risk for anxiety problems, 40% was at risk for cognitive problems, and 80% was at risk for communication problems.Conclusion Thirteen to 18-year-old children with non complex CHD have poorer physical function than healthy children. Post operative children are at risk for physical appearance, anxiety, cognitive, and communication problems.

Gambaran Klinis dan Kelainan Imunologis pada Anak dengan Lupus Eritematosus Sistemik di Rumah Sakit Umum Pusat Adam Malik Medan

Latar belakang. Lupus eritematosus sistemik (LES) adalah penyakit autoimun sistemik yang disebabkan oleh keterkaitan faktor lingkungan, hormonal dan genetik. Manifestasi klinis dan hasil laboratorium diperlukan untuk menegakkan diagnosis LES. Tujuan. Untuk melihat pola gambaran klinis dan abnormalitas laboratorium pada anak LES yang datang ke Poli Alergi Imunologi Anak Rumah Sakit Umum Pusat Adam Malik, Medan. Metode. Penelitian merupakan studi deskriptif terhadap 12 anak dengan diagnosis LES berdasarkan kriteria American College of Rheumatology(ACR) revisi yang datang ke Poliklinik Alergi Imunologi Anak RSUP Adam Malik Medan sejak tahun 2006-2010. Catatan medis pasien LES dikumpulkan untuk melihat gambaran klinis dan kelainan imunologis. Hasil. Dua belas pasien memenuhi kriteria ACR yang direvisi, terdiri dari 11 anak perempuan dan satu anak laki-laki, dengan rerata usia 10,25 (antara 3-15 tahun). Semua pasien dengan manifestasi klinis demam, ruam kulit berbentuk kupu-kupu, nyeri sendi dan penurunan berat badan. Pemeriksaan laboratorium pada semua pasien menunjukkan anemia, test ANA positif, dan kenaikan titer anti ds-DNAKesimpulan. Demam, ruam kupu-kupu, nyeri sendi dan penurunan berat badan merupakan manifestasi klinis yang paling sering dan ditemukan pada semua pasien.Anemia, test ANA positif, dan kenaikan titer anti-dsDNA juga ditemukan pada semua pasien.

Studi Deskriptif Infeksi HIV pada Anak di Rumah Sakit Umum Pusat Adam Malik Medan

Latar belakang. Anak mendapat infeksi HIV terutama akibat transmisi selama dalam kandungan, saat persalinan, dan saat mendapat air susu ibu. Bayi dan anak yang terinfeksi HIV kemungkinan akan berkembang menjadi acquired immunodeficiency syndrome(AIDS) atau akan tetap asimtomatis sampai beberapa tahun sebelum terjadi infeksi oportunistik. Tujuan. Menilai profil infeksi HIV di Departemen Ilmu Kesehatan Anak, Fakultas Kedokteran Universitas Sumatera Utara, Rumah Sakit Umum Pusat Adam Malik, Medan.Metode. Penelitian deskriptif retrospektif terhadap semua anak dengan infeksi HIV antara tahun 2006 sampai 2010. Diagnosis ditegakkan berdasarkan anamnesis, pemeriksaan fisik, dan pemeriksaan laboratorium. Hasil. Selama periode 5 tahun didapatkan 53 anak dengan diagnosis infeksi HIV (35 laki-laki dan 18 perempuan), 46 (86,8%) lahir secara spontan dan 7 (13,2%) dengan seksio sesaria. Dari riwayat pemberian makan saat bayi, Asi dan formula diberikan kepada 41 (77,4%) anak dan 12 (22,6%) anak hanya mendapat susu formula. Supresi imun berat terdapat pada 38 (71,7%) anak, supresi imun sedang pada 8 (15,1%), supresi imun ringan pada 2 (3,8%) anak dan 5 (9,4%) anak tanpa supresi imun. Malnutrisi berat ditemukan pada 30 (56,6%) anak, 16 (30,1%) malnutrisi sedang, dan 7 (13,2%) anak gizi normal. Gambaran klinis adalah malnutrisi berat pada 30 (56,6%) anak, kandidiasis mulut 18 (34%) anak dan diikuti dengan diare berkepanjangan 14 (26,4%) anak dan tuberkulosis pada 13 (24,5%) anak. Empat puluh lima (84,9%) anak memiliki kedua orang tua positif terinfeksi HIV, 6 (11,3%) anak hanya ibu yang positif HIV, dan 2 (3,8%) anak kedua orang tuanya tidak terinfeksi HIV (satu anak adopsi dan satu lagi ada riwayat transfusi). Tiga puluh tujuh (69,8%) anak sudah mendapat terapi antiretroviral (ART), 8 (15,2%) anak belum terindikasi ART, dan 8 (15,2%) anak hilang dari pemantauan. Tiga puluh sembilan (73,6%) anak masih hidup, 6 (11,3%) anak sudah meninggal, dan 8 (15,1%) anak tidak diketahui. Kesimpulan. Anak dengan infeksi HIV mayoritas lahir secara spontan, mendapat ASI campur susu formula dan mengalami malnutrisi berat serta supresi imun berat saat diagnosis ditegakkan.

Association of body mass index with atopy and allergic diseases

Background Prevalence of atopy, allergic diseases, and obesity are increasing. Atopy is an individu and/or familial tendency to sensitization in response to ordinary exposure to allergens. Obesity is defined as body mass index (BMI) greater or equal to 95 percentile. Research on association of BMI with atopy and allergic diseases in children were limited, with inconclusive results. Objective To assess association of BMI with atopy and allergic diseases in chidren.Methods A cross-sectional was conducted in school children aged 6-12 years in Lhokseumawe City, Aceh, June 2012. Children were assessed for BMI, skin prick test, and  International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Statistical analyses included Chi-square, Fisher exact, and logistic regression.Results Children consisted of 137 (85.6%) normoweight, 12 (7.5%) overweight, and 11 (6.9%) obesity. Skin prick test results were positive in 44 (27.5%) and negative in 116 (72.5%) subjects. Allergic manifestations were allergic rhinitis (AR) 17 (10.6%), bronchial asthma 6 (3.8%), and atopic dermatitis (AD) 3 (1.9%). There was significant association of obesity with atopy, compared with normoweight (OR=3.78; 95%CI 1.08 to 13.19; P=0.037), but no significant association found when family history of atopy also assesed. There was significant association of obesity with bronchial asthma (OR=9.92; 95%CI 1.46 to 67.18; P=0.004) and AR (OR=6.49; 95%CI 1.64 to 25.66; P=0.015), compared with normoweight. Significant association of overweight with atopy and allergic disease was not found.Conclusion Obesity significantly associates with atopy, bronchial asthma, and AR, but overweight and normoweight  do not.  

Additional probiotic therapy lowers SCORAD index in children with atopic dermatitis

Background <br />Atopic dermatitis (AD) is a common skin disease that is usually chronic, relapsing, causing pruritus and frequent in children. The pathogenesis of AD involves genetic, immunological and environmental factors causing skin barrier dysfunction and dysregulation of the immune system. Probiotic treatment has been claimed to offer several functional properties including stimulation of the immune system and plays an important role in AD. The objective of this study was to evaluate the effect of probiotic therapy on atopic dermatitis in children.<br /><br />Methods <br />A randomized controlled trial was conducted on 62 children suffering from AD from December 2015 to January 2016. AD severity was assessed based on the scoring of atopic dermatitis (SCORAD) index. Subjects were divided into two groups consisting of 32 and 30 children, the probiotic (probiotic + emollient) and control (emollient) groups, respectively. SCORAD index was re-evaluated after 2 weeks of therapy. The data was analyzed using Mann Whitney test.<br /><br />Results <br />After the intervention, the mean SCORAD index in the probiotic group was significantly much lower than the control group (18.09 ± 8.59 vs 23.21 ± 8.71; p=0.001). The mean decrease in SCORAD index in the probiotic group was 40.4 %, much higher than the control group 25.2%. The number needed to treat (NNT) score of probiotic treatment was 5.3.<br /><br />Conclusion <br />The addition of probiotics to conventional therapy effectively lowers SCORAD index by 40.4% in atopic dermatitis. The impact of probiotics on SCORAD indices is thought to be attained by modification of the immunogenicity of potential allergens.

Selenium for acute watery diarrhea in children

Background Acute watery diarrhea remains a major health problem affecting infants and children in developing countries. Selenium deficiency may be a risk factor for diarrhea and vice versa. Few studies have been conducted on the effectiveness of selenium for the treatment of diarrhea in children.Objective To determine the effectiveness of selenium in reducing the severity of acute watery diarrhea in children.Methods A single-blind, randomized clinical trial was done in children with acute watery diarrhea, aged six months to two years, and who visited the community health center in Simalungun from May to August 2012. Children were randomized into either the selenium or placebo (maltodextrin) group. We monitored diarrheal frequency, stool consistency, and duration of diarrhea. Mann-Whitney, Fisher’s, and Kolmogorov-Smirnov tests were used to compare the two groups.Results Sixty-five children were recruited into the study, of whom 36 children received selenium and 29 children received a placebo. The selenium group had significantly lower frequency of diarrhea (bouts per day) than the placebo group on days 2, 3, and 4 after treatment onset [day 2: 3.5 vs. 4.1, respectively (P=0.016); day 3: 2.7 vs. 3.4, respectively (P=0.002); day 4: 2.1 vs. 2.8, respectively (P<0.001)]. On day 2, stool consistency had significantly improved in the selenium group compared to the placebo group (P=0.034). In addition, the median duration of diarrhea was significantly lower in the selenium group than in the placebo group (60 vs. 72 hours, respectively; P=0.001). Median recovery time from the the first day of diarrhea was also significantly lower in the selenium group than in the placebo group (108 vs. 120 hours, respectively; P=0.009).Conclusion In children with acute watery diarrhea, those treated with selenium have decreased frequency of diarrhea, improved stool consistency, as well as shorter duration of diarrhea and recovery time than those treated with a placebo. [Paediatr Indones. 2016;56:139-43.].

Number of siblings and allergic rhinitis in children

Background Allergic rhinitis is one of the most common chronic diseases of childhood. Recent studies have suggested that having fewer siblings was associated with allergic rhinitis and atopic diseases in children. Previous studies also indicated that older siblings was associated with higher incidence of allergic rhinitis.Objectives To assess for a possible association between number of siblings and allergic rhinitis and to assess for an effect of birth order on allergic rhinitis in children.Methods We performed a cross-sectional study among school children aged 7 to 15 years, in the West Medan District from July to August 2011. Children with moderate or high risk of allergy were included. Subjects were divided into two groups, those with <3 siblings or ≥3 siblings. Children with acute respiratory tract infections, septal deviation, choanal atresia, nasal polyps, nasal tumors, or nasal foreign body were excluded. Risk of allergy was determined using the Indonesian Pediatrics Allergy Immunology Working Group trace card scoring system. Identification of allergic rhinitis and evaluation of its severity were done by use of the International Study of Asthma and Allergies in Childhood (ISAAC) core questionnaire. Allergic rhinitis was diagnosed based on history, physical examination, and anterior rhinoscopy.Results A total of 78 subjects were enrolled. Allergic rhinitis was significantly higher in children with <3 siblings than those with ≥3 siblings (OR 10.33; 95%CI 3.569 to 29.916). Furthermore, allergic rhinitis was significantly higher in first-born children than in their younger siblings (P=0.0001).Conclusion Larger number of siblings and non-first-born children are associated with lower incidence of allergic rhinitis in children.

Skin prick test reactivity in atopic children and their number of siblings

Background Some studies have shown that low birth order is a risk factor for developing atopy, although these results remain inconclusive. Those studies put forth the hygiene hypothesis, which states that early childhood infections in siblings may protect against atopy. Hence, an inverse relationship between family numbers and atopy was found. Atopy may be diagnosed from a history of atopy in an individual or his family, and can be confirmed by specific IgE for allergens or positive skin prick tests.Objective To assess for an association between skin prick test reactivity in atopic children and their number of siblings.Methods A cross-sectional study was conducted in May to June 2010 in elementary school children at the Kampung Baru District, Medan Regency, North Sumatera. Subjects were divided into two groups. Group I had children with < 3 siblings and group II had children with ≥ 3 siblings. Skin prick tests were done in 7 to 10-year-old children with a history of asthma, allergic rhinitis and atopic dermatitis. Skin prick test reactivity results were analyzed by Chi-square test.Results A total of 192 subjects were enrolled in this study, with 96 subjects in each group. Positive skin prick tests were significantly higher in subjects with <3 siblings than in those with >3 siblings (75% and 53.1%, respectively; P=0.003).Conclusion Atopic children with <3 siblings had more positive skin prick tests than children with >3 siblings.

Association between bronchial asthma in atopic children and their number of siblings

Background The prevalence of asthma in children has increased in many countries. Environmental factors are believed to play an important role and an inverse relationship between number of siblings and atopic disorders has been observed.Objective To assess for an association between bronchial asthma in atopic children and their number of siblings.Methods A cross-secrional study was conducted from June to November 2010 in three elementary schools in Medan, North Sumatera. Trace cards from the Allergy-Immunology Indonesian Pediatric Association (IDAI) Working Group and questionnaires on the clinical history of atopy were used to screen children with the risk of atopy. The International Study of .Asthma and Allergies in Childhood (ISAAC) questionnaire to screen for bronchial asthma was distributed to children aged 7-10 years with a history of asthma, allergic rhinitis or atopic dermatitis. Subjects were divided into two groups, those with <3 siblings and those with 2:3 siblings. Chi-square test was used to analyze differences in bronchial asthma prevalence between the two groups.Results Ninety-six subjects enrolled in the study, with 48 subjects per group. The prevalence of bronchial asthma was significantly higher in atopic children who had <3 siblings than in children with 2:3 siblings (73.5% and 26.5%, respectively; P=0.04).Conclusion Bronchial asthma was significantly more frequent in children with less than 3 siblings compared to those with 3 or more siblings.

Total serum IgE levels in soil-transmitted helminth infected children with atopy symptoms

Background High total serum immunoglobulin E (IgE) levelsand eosinophilia are markers for atopy, but other factors mayalso play a key role in affecting atopy, such as intestinal parasiticinfection. Helminthiasis has been associated with a reduced riskof atopy and asthma symptoms in areas with high prevalence ofparasitic infections.Objective To assess for associations between total serum IgElevel and soil-transmitted helminthiasis (STH) infection, as wellas between STH infection and allergy symptoms.Methods We conducted a cross-sectional stu dy on 84consecutively-enrolled children , aged 7- 13 years, in theSecanggang Subdistrict, Langkat District, North SumateraProvince. Subjects were enrolled into one of two groups, with orwithout STH infection. Total serum IgE measurements and stoolSTH examinations were performed in all subjects. Data on atopyor allergy symptoms were obtained by parental interview.Results The 42 subjects with STH infection had significantlyhigher mean total serum lg E levels than the 42 subjects withoutinfec tion, 1,13 1.26 IU/mL and 744.76 IU/mL, respectiv ely(P = 0.029). We also fo und significant positive association sbetween STH infection and asthma symptoms (P= 0.049), as wellas eczema symptoms (P=0.044).Conclusion Mean total serum IgE level is higher in STHinfectedsubjects than in those without infection. In addition,STH infection is positively associated with asthma and eczemasymptoms.

Soil-transmitted helminth infection and skin prick test reactivity in children

Background Allergic diseases cause an increasingly largeburden in developed countries and in urban areas of middleincomecountries . Paras itic infections may induce allergicresponses in humans, particularly soil-transmitted helminth(STH) infections that are prevalent in childhood in developingcountries. Although soil-transmitted helminth infec tions havebeen associated with lower prevalence of allergen skin testreactivity, study outcomes remain inconclusive.Objective To analyze for an association between STH infectionsand skin prick test reactivity in children.Methods We conducted a cross-sectional study in August 2009among primary school students aged 7- 12 years, at SecanggangSubdistrict, Langkat District, North Sumatera Province. Sixtyeight children were recruited in this study consisted of 34 childrenwith STH infections and the other 34 children without any STHinfection. Soil-transmitted helminth infections were determinedby Kato-Katz stool examination s. All subjects underwent skinprick tests for seven allergens. Results were con sidered to bepositive if wheal diameters 2: 3 mm and negative when whealdiameters < 3 mm. Data was an alysed by Chi-square test.Results Stool examinations revealed that the most commoninfec tion was T. trichiura (18/34 subjects), followed by mixedinfections (T. trichiura and A lumbricoides; 12/34 subjects), andA. lumbricoides (4134 subjects). There was a significant associationbetween STH infections and negative skin prick test (P= 0.002).In addition, there were significant associations with negative skinprick tests for each helminth type: A. lumbricoides (P=0.001) ,T. trichiura (P=0.01) and mixed infection (P = 0.006). Severeinfection intensity was also significantly associated with negativeskin prick tests (P=0.031) .Conclusion Children with STH infections tend to have negativeskin prick test results.

Efficacy comparison of cetirizine and loratadine for allergic rhinitis in children

Background Allergic rhinitis represents a global health problemaffecting 10% to more than 40% of the population worldwide.Several studies in recent years have described the efficacy ofsecond-generation antihistamines in younger children. It isnot well established whether cetirizine is more effective thanloratadine in reducing symptoms of allergic rhinitis.Objective The objective of this study was to compare the efficacyof loratadine with cetirizine for treatment of allergic rhinitis.Methods We conducted a randomized, double-blind, controlledtrial of 100 children, aged 13 to 16 years, from October toNovember 2009 at two junior high schools in Medan. GroupI received 10 mg of cetirizine and group II received 10 mg ofloratadine, each once daily in the morning for 14 days. Drugefficacy was assessed by changes from baseline symptom scoresand evaluation of therapeutic responses after 3 days, 7 days and14 days of treatment.Results The efficacy of cetirizine compared to that of loratadinewas not statistically significant in diminishing nasal symptomsafter 3 days, 7 days and 14 days of treatment (P=0.40, P=0.07,and P=0.057, respectively). Evaluation of side effects, however,revealed significantly fewer headaches in the cetirizine group after3 days and 7 days of treatment (P=0.01 and P=0.03, respectively)than in the loratidine group. In addition, the loratadine grouphad significantly more instances of palpitations after 7 days oftreatment (P=0.04) compared to the cetirizine group.Conclusion There was no significant difference in cetirizine andloratadine treatment effectiveness on allergic rhinitis. However,loratadine was found to cause more headaches and palpitationsthan cetirizine. [Paediatr lndones. 2012;52:61-6].